Sentinel Node in Endometrial Cancer: Rationale and Early Experience

Abstract

The lymph node status is a key factor in staging, prognosis and adjuvant treatment planning of endometrial cancer (EC). Systematic pelvic and para-aortic lymphadenectomy is the only reliable procedure to assess the lymph-node status and it should be the standard of care in most cases with risk factors for node metastasis. However, it has no therapeutic benefit on the course of the disease for the majority of patients without nodal disease. The procedure is difficult, costly, time consuming, and it is not free of potentially severe complications and long-term disabling morbidities. Therefore, the real challenge would be to identify a surgical technique that provided accurate staging information about nodal status while avoiding the potential for overtreating low-risk patients and undertreating patients with metastasic disease. Lymphatic mapping and sentinel lymph node (SLN) selective biopsy is a promising technique for this purpose, avoiding a systematic lymphadenectomy in most cases, and providing useful information for surgical planning and approach. However, research on SLN in EC is very much behind vulvar or cervix cancer. The lack of standardization of the procedure is probably the main cause of the delay in the investigation and final implementation of SLN technique in EC.